Objective To evaluate the effects of 6% hydroxyethyl starch (HES)130/0.4 and 6% HES 200/0.5 on blood coagulation in patients undergoing major operation under general anesthesia.Methods Sixty ASA Ⅰ or Ⅱ patients aged 18-64 yr undergoing major operation under general anesthesia during which the blood loss was expected to be＞20%of blood volume were allocated randomly into 3 groups(n=20 each):Ⅰ control group(C);Ⅱ6% HES200/0.5 group (H) and Ⅲ HES130/0.4 group (V).In group H and V the patients Arterial blood samples were taken before(T1),immediately(T2)and 1 h after the end of fluid infusion(T3)for determination of hematocrit(Hct),platelet count(PLT)and prothrombin time(PT),platelet maximum aggregation test induced by 5 μmol/L ADP,and Sonoclot coagulation and platelet function analysis(gbACT,CR,PF,TP).Activated partial thromboplastin time(Am),coagulation factor Ⅷ (FⅧ)activity and von Willebrand factor(vWF)were measured only in group H and V.Results (1) PT and APTT were significantly prolonged after fluid infusion at T2 and T3 as compared with the baseline values at T1 in group H and V.(2)FⅧ activity and platelet maximum aggregation induced by ADP were significantly decreased at the end of fluid infusion at T2 as compared with the baseline at T1 but increased again at T3 in group H and V.(3)There was no significant change in Sonoclot coagulation parameters after fluid infusion as compared with the baseline except clot formation rate (CR)in group H and V.Conclusion Acute hypervolemic hemodilution with 6% HES130/0.4 or 200/0.5 has minimal effect on blood coagulation and there is no significant difference in blood coagulation changes induced by 6%HES130/0.4 and 200/0.5.

Objective To determine intra-operative changes in blood coagulation and the applicability of SCA in liver transplantation. Methods Twenty-four patients with end-stage liver disease undergoing or-thotopic Liver transplantation (OLT) were studied. Arterial blood samples were drawn for determination of celite-activated TEG, glass bead-activated SCA and RCT at 6 intervals: before anesthesia induction (T0), 60 min after operation was started (T1), 30 miu in anhepatic phase (T2), 30 min in neohepatic phase (T3) ,120 min in neohepatic phase (T4) and the end of the operation (T5) ; the variables of TEG includ-ed: reaction time(R) ,coagulation time(K), alpha angles (α) and maximal amplitude (MA) ; the variables of SCA included: activated clotting time (ACT), clot rate (CR) and platelet function(PF) ;RCT included: Plt, PT, INR, APTT, Fbg. Results The Kappa values of SCA and TEG diagnosing the deficiency of blood coagulation factors, the gel formation speed of fibrin and the function of platelet were respectively 0.371 (P < 0.05) ,0. 363 (P < 0.05) ,0.438 (P < 0.05). gbACT and R, CR and α, PF and MA were positive-ly correlative (r = 0. 790, P < 0.05 ; r = 0. 766, P < 0. 05 ; r = 0. 502, P < 0.05 ; respectively) ; CR and K were negatively correlative(r = -0. 588,P <0.05). Compared with T0, PT, INR, gbACT and R were pro-longed, FBG, CR, α and MA were decreased at T3-5 (P < 0.05). APTT was prolonged at T1 ～ T5 (P < 0.05). K was prolonged at T3 (P < 0.05) and PF was decreased at T2 ～ T4. Conclusion SCA can exactly monitor changes of blood coagulation in liver transplantation.

Bacterial resistance to antibiotics is currently a serious health concern.According to the data from the surveil-lance of bacterial resistance in China ( CHINET) ,the isolation rates of gram-negative bacteria have been rising annually. Among the gram-negative organisms, the isolation rate of Carbapenem-resistant enterobacteriaceae, especially extensive drug-resistant strains,has been increasing rapidly.The isolation rate of extensive drug-resistant or pandrug-resistant non-fermenting bacteria,es-pecially Acinetobacter baumanii,is still relatively high.These extensive drug-resistant gram-negative bacteria cause high mortality, which has drawn great attention in clinical settings.On the part of multidrug-assistant gram-positive bacteria,the isolation rate of vancomycin-resistant enterococci remains stable but rates of methicillin-resistant Staphylococcus aureus and coagulase-negative staphylococci are still high.Staphylococcal strains have not yet been found resistant to vancomycin in China.Understanding the epi-demiology of local drug-resistant bacteria facilitates the development of appropriate antibiotic strategies. The mortality of patients with severe infection may be improved by early use of antibiotics and appropriate de-escalation therapy.Rational use of antibiotics and recognition of the influence factors,such as antibiotic-induced endotoxin release,may maximize the efficacy of antibiotics and minimize the adverse reactions.

Objective To investigate the effects of statins on coronary artery disease in patients with coro-nary heart disease and lipid regulating effect on curative effect .Methods 126 cases of patients with coronary heart disease were randomly divided into the control group of 60 cases and 66 cases in the treatment group ,the control group was given routine treatment of coronary heart disease ,the treatment group was treated with routine treatment with simv-astatin bedtime,before treatment and after 3,12 months when the determination of lipids ,liver function and renal func-tion index,and compared between the two groups of cardiovascular events .Results 3 months after treatment , TG, TC,LDL-C of the treatment group decreased significantly ,while the control group in 3,12 months after treatment,TC, TG,LDL-C had the rise of certain level(t=5.43,5.21,4.85,all P<0.05).The two groups after treatment in 3, 12 months in TC,TG,LDL-C had significant differences(t=5.32,5.78,5.64,6.15,6.41,6.06,all P<0.05).Dur-ing follow-up,patients in the treatment group 33 cases of cardiovascular events ,the control group of 81 cases,two groups of cardiovascular event rate had a significant difference (χ2 =13.42,P<0.01).Conclusion Statins can re-duce blood lipids in patients with coronary artery disease ,thereby reducing the patients appear related to cardiovascu-lar accidents,improve the treatment effect of coronary heart disease .

11?-hydroxylase deficiency is one of the main causes of congenital adrenal hyperplasia (CAH),which is caused by the mutation of CYP11B1 gene that encodes the enzyme.Researches have shown that mutations of CYP11B1 gene would result in decreased activity or inactivation of the enzyme in classical 11?- hydroxylase deficiency,and their relationship between genotype and phenotype of 11?-hydroxylase deficiency is not clear.

Objective To evaluate the reliability and accuracy of the fully automated erythrocyte sedimentation rate (ESR) analy‐ser Monitor‐100 for determining ESR .Methods 146 outpatients and inpatinets were selected and detected ESR by the fully automa‐ted ESR analyser 1 h ,30 min and the Westergren method .Then these three kinds of method were compared and the repeatability test was performed .Results (1)The ESR values determined by the analyser 1 h ,analyser 30 min and Westergren method were 37 . 8 ± 34 .1 ,38 .1 ± 33 .7 ,36 .4 ± 32 .9 respectively ,there were no statistical significance between any two methods (P>0 .05) .(2)The detection rates of the positive results by the analyser 1 h ,analyser 30 min and Westergren method were 43 .2% ,44 .5% and 45 .2%respectively ,no statistical difference between them was found (P>0 .05) .(3)The Kapper values between the analyser 30 min with the analyser1h ,between the analyser 30 min with the Westergren method and between the analyzer 1h with the Westergren method were 0 .944 ,0 .875 and 0 .903 .4 respectively .(4)The CV values in the repeatability test were very lower and within the acceptable limits .Conclusion Compared with the Westergren method ,the fully automated ESR analyser Monitor‐100 has lower false positive rate and lower false negative rate ,moreover its consistency and repeatability are excellent ,it is convenient ,fast ,safe and should be largely promoted in clinic .

Antitubercular Agents ; therapeutic use ; Child ; Child, Preschool ; Diagnostic Errors ; Female ; Fever ; etiology ; Humans ; Infant ; Male ; Pediatrics ; Tuberculosis ; drug therapy ; microbiology ; physiopathology ; X-Ray Film

Objective To investigate the neurogranin expression in the rat neocortical and hippocampal regions after kainci acid(KA) induced limbic seizures.Methods 52 SD rats were divided randomly into KA group and normal control group.The animals of KA group were injucted KA to kindling the seizures and sacrificed at the end of 6 h,12 h,18 h,24 h,and 48 h respectively after seizures induced.By using fluorescent immunostain combined with confocal microscope,neurogranin expression and distribution were examined in the cerebral cortex and different regions of hippocampal.Western Blot technique was specially used to analyze the quantitative level of protein involved in the relate areas.Results Strong expression of neurogranin was present in cytoplasm of layers Ⅱand Ⅲ cortical,CA_1,CA_3 pyramidal cells and dentate gyrus granule cells of normal control groups.Rats after 18 h KA injection began to exhibit decreased expression of neurogranin in the cortex significantly((P

The alterations of ultrastrueture in rat kidney were observed under transmission electron microscopy, results showed that both glomerular filtration membranes and renal tubules had changed immediately after repeated loaded swimming and there were consistency between the recovery of renal ultrastructures and that of urinary protein and excration rate.

Objective To study a safe method to dissect cystic duct under laparoscope. Methods Clinical data of 300 cases of posterior Calot's triangle approach laparoscopic cholecystectomy (LC) from November 2000 to April 2003 were analyzed respectively. Results Posterior Calot's triangle approach LC was successfully carried out in 282 cases while a conversion to open surgery was required in 18 cases (6%, 18/300). Postoperative complications were observed in 2 cases (0.7%, 2/300). Conclusions Posterior Calot's triangle approach LC is a safe procedure and simple to operate.